Organization
SPACE COAST CENTER FOR INDEPENDENT LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL L DUNHAM-SCHULLER (EXECUTIVE DIRECTOR)
(321) 633-6011
Entity
Organization
Contact information
Practice address
571 HAVERTY CT STE W, ROCKLEDGE, FL 32955-3614
(321) 633-6011
(321) 633-6472
Mailing address
571 HAVERTY CT STE W, ROCKLEDGE, FL 32955-3614
(321) 633-6011
(321) 633-6472
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003421900
—
FL
Enumeration date
04/25/2012
Last updated
04/25/2012
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